# Rural admission quota in Germany: students’ attitudes, challenges and the need for support programmes

## TL;DR

This study explores the attitudes and challenges of German medical students admitted under a rural doctor quota program, highlighting the need for support to ensure their success in rural practice.

## Contribution

The first cross-location analysis of Bavarian Rural Doctor Quota students' attitudes and challenges, revealing specific stressors and support needs.

## Key findings

- RDQ students show positive attitudes toward rural general practice but face stress from contract obligations and financial strains.
- Non-RDQ students expressed concerns about commitment and socio-economic advantages associated with the quota.
- Targeted support programs, including financial aid and curriculum adjustments, are needed to sustain RDQ students' commitment.

## Abstract

The shortage of general practitioners, especially in rural and underserved areas, is a pressing issue worldwide and also in Germany. To address this, several German federal states have introduced the Rural Doctor Quota (RDQ), which allocates study places in advance in exchange for a commitment to complete specialist training and work as a family doctor in a rural region. Despite its implementation, little is known about students’ attitudes toward the RDQ or the potential burdens associated with quota admission. This study provides the first cross-location description of RDQ students in Bavaria across all five medical faculties, focusing on their attitudes and on the assessment of potential burdens associated with this quota.

A cross-sectional online survey was conducted among RDQ students and a control group of other students in their first to fourth year at all five Bavarian medical faculties. Participants completed Likert-scale items on attitudes towards rural practice and stress related to contractual obligations and indirect effects in association with the quota, complemented by free-text responses. Quantitative data were analysed descriptively, while free text responses were processed via structured content analysis, following Kuckartz, to identify core themes.

Of 359 respondents, 158 were students admitted through the Bavarian rural doctor quota (RDQ), and 201 were Non-RDQ students. RDQ students expressed positive attitudes towards rural general practice. Stress due to contract obligations was highest regarding uncertainty about future working regions and time commitment, while specialty and rural placement restrictions were less burdensome. Social stigma was stated to be low, though concerns about commitment or socio-economic advantages were expressed by Non-RDQ students. RDQ students reported higher financial strains and more study-work conflicts.

RDQ students face particular challenges and need targeted support in the form of structured and multi-layered university programmes, next to financial support options. Rural placement, an in-depth curriculum and social network support can further promote students’ positive attitudes towards rural general practice and their commitment to the programme.

The online version contains supplementary material available at 10.1186/s12909-026-08776-w.